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Z <br /> P �] ° <br /> Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator < _ <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER ± J .� �I„ . _ n � TELEPHONE ) <br /> MAILING ADDRESS µ �. <br /> T <br /> PROPERTY ADDRESS f/Iff7� �I Q �rC C I,ry)�/ 1 .+�-- o <br /> LEGAL DESCRIPTION Q <br /> 0 <br /> N <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING 0 ADDITION 0 DECK 0 GARAGE/ACCESSORY STRUCTURE I <br /> BUNKHOUSE 0 59.692(1V)GAZEBO 0 STAIRS 0 FILLING/GRADING 0 CAMPING UNIT❑ -o <br /> COMMERCIAL BUILDING 0 CO <br /> MMERCIALADDITIONY COMMERCIAL ACCESSORY STRUCTURE ❑ S <br /> I_1(c,, }J o <br /> STRUCTURE/ADDITION USE: 1 1 11�GL�I e- 3Y 12 f x.Z0r <br /> (Ho abin;Commercial Business; Bedroom; Deck;etc.) <br /> BUILDING CONTRACTOR: r' <br /> O 3 <br /> � o <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Vz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS y <br /> WILL BE RETURNED. 'n <br /> n a <br /> m o <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) c <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. r" <br /> as <br /> 2. SHOW THE LOCATION AND SIZE OF ALL IXISTING BUILDINGS/STRUCTURES(EB)AND ALL NEW 0n <br /> BUILDINGS/STRUCTURES(NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, —J N c <br /> AND INDICATE NORTH (N). O z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B) BUILDING(S) ❑ ° <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK O G <br /> (OHWM)OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND(D) LOT DIMENSIONS. <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES I <br /> TO BUILDINGS, ROADS,LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE 3 �( <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. ",1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN w <br /> NEEDED. v <br /> f^I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> I n <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. Z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. N z <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER Q �I <br /> SETBACK AREA. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. 9 <br /> NOT TO BE USED FOR HUMAN HABITATION. CJ F <br /> 6. Q <br /> 7. > o 0 0 c [�z1 <br /> 3 3 3 m <br /> N <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my 3 <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all n m d a y <br /> information contained in this application(including any accompanying schedule)and I further declare that I recognize that this E. D m N <br /> information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I m a a a'" '9 <br /> further accept all liability that may be a result of the County of Burnett relying on this information I am providing in this <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to <br /> have access to the above-descri ed premises at any reasonable time for the purpose of inspection. w s�sws (� <br /> ctl 2 � wg ,noo > <br /> OWNER'S SIGNATURE C r _ r ,t�� 3 A c 0 0 0 <br /> (date U n � 9`� _nO <br /> ZONING ADMINISTRATOR (O/ <br /> JUN 5 2012 <br /> T WNSHIP PERMITS MAY BE REQUIRED d e <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISIS COUNTY g <br /> ZONING <br /> 0 0 0 0 0 <br />